Bone clamping and wire adjusting means



y 28, 1942- J. R. SIEBRANDT BONE CLAMPING AND WIRE ADJUSTING" MEANS Filed June 15, 1941 mvaqrroR J12. Szebmndz, E z A k' /tM Lvd Patented July 28, 1942 BONE CLAMPING AND WIRE ADJUSTING MEANS John R. Siebrandt, Kansas City, Mo.

Application June 13, 1941, Serial No. 397,915

4 Claims.

The present invention relates to surgical devices and operations, and has particular reference to instruments or appliances of the character employed in the reduction of bone fractures for holding the parts of the fracture in proper position for facilitating the application of the securing or fixation means designed to hold the parts permanently together.

One of the principal objects of the invention is to provide a bone-clamping instrument resembling a forceps design, and provided with a drillguiding attachment mounted adjustable on one of the jaws of the instrument for enabling the drilling operation to be carried out at any desired angle with reference to the fragments of the bone fracture. In this connection the invention aims to improve the facilities for threading the fixation material through the openings prepared for same in the fracture, and also for retracting the ends of said material into position outside the wound, for enabling the said ends to be properly secured together.

Accordingly one outstanding feature of the improved construction is the provision of means whereby one of the jaws of the instrument will receive and eifectively engage the inserted end of the wire or fixation material, whereupon the retraction of the appliance will result in corresponding retraction or withdrawal of both ends of the fixation material, especially as used in the reduction of the rather long fractures of relatively small bones. Following said withdrawal of the wire ends, the appliance is adapted for carrying out the twisting operation necessary for securely fastening said ends in permanently secured relation to the fracture.

It is also an important object of the invention to provide a device or instrument of the character described with clamping means for securely holding the instrument with its jaws in operative or clamping relation, with no opportunity for casual release of the same; and in this connection provision is also made for calibrating one member of the said securing or clamping means as a valuable accessory for indicating the degree or extent of spread of the clamping jaws and hence the size of the fracture, and by the same token the size of drills, screws, etc., required to be used in the operation.

With the foregoing general objects in view the invention will now be described by reference to the accompanying drawing illustrating one practical and efficient form of construction found suitable for the embodiment of the proposed improvements, after which those features and combinations believed to be novel and patentable will be particularly set forth and claimed.

In the drawing- Figure 1 is a perspective view showing an instrument or appliance constructed in accordance with the present invention;

Figure 2 is a side elevation and partly sectional view, on a larger scale, showing the appliance as used in connection with a bone fracture and for facilitating the insertion of the wire fixation materialthe ends of the handles and their securing means being broken away;

Figure 3 is a similar View, with one of the handles and its jaw retracted for correspondingly withdrawing one end of the wire;

Figure 4 is also a fragmentary elevation showing the appliance entirely withdrawn from boneclamping relation and its working jaws reengaged in clamping engagement with the ends of the wire fixation material preparatory to twisting the same and complete the operation; and

Figure 5 is a perspective detail view of an adjustable securing nut forming part of the appliance.

The present invention involves certain improvements over the subject matter of my Patent No. 2,181,746, dated November 28, 1939. Accordingly, the invention comprises a forceps type of bone-clamping instrument having not only an efiicient and adjustable drill-guide attachment :but also an improved form of construction whereby the wire fixation material may be readily and quickly introduced in place and also both ends thereof properly retracted or withdrawn from the wound into position for securing said fixation material by twisting the end portions of the wire.

Referring now to the drawing in detail, the bone clamping instrument is illustrated as comprising a pair of handle portions H1 and II formed with curved jaws l2 and M having the longitudinal slots l9 and 18 respectively. The upper jaw i2 is formed with transverse serrations it at opposite sides of the slot l9, whereas the lower jaw H5 is simply made of scoop or concave contour with ridge projections 9 along its opposite longitudinal edges, adapted to serve as scraping edges as hereinafter explained. The tip ends of the jaws are tapered down to thin straight edges adapted to facilitate entry between the bone and tissues, and also for even clamping engagement with the several strands of wire ends preparatory to twisting the same at the end of the operation.

The handles and jaw members are pivotally connected for operation in the manner of a forceps instrument by means of a pivot element l6 carried by one of the members and adapted to be received within an inclined slot IT in the other member,the angular relation of said slot permitting the withdrawal of the latter member in an approximately lengthwise direction as provided for in the patent already referred to.

The drill guiding attachment is herein shown as comprising an arch-shaped support adapted for adjusting movement lengthwise of the jaw l2, the sides of said support resting upon the opposite sides of the slot l9, and the middle portion of the support having fingers 2i projecting down within said slot for guiding and retaining engagement with the inside faces thereof see Figures 1 and 2. The main arch-shaped portion of the support 26 is formed with a slot 22 extending transversely with reference to the jaw ii, for adjustably accommodating the threaded shank portion 24 of a tubular drill guide element which is formed with a head portion 25 of larger diameter than the slot [9 and of convex shape for conforming to the concave contour of the inner face of said jaw l2 at opposite sides of said slot and which contour corresponds to the curved outer face of the support 20, as shown.

The curved outer face of the support 26 is designed to be engaged by a nut 28 carried by the outer end of the guide element for securing the parts in any position reached by the combined adjustment along either or both of said slots I9 and 22.

As in said prior patent, a clamping or looking means is provided for the ends of the handles it and I l, which consists of a curved and threaded bar 30 pivoted at 3| to the outer end of the handle Hi3 and adapted to swing into and out of a terminal slot 32 in the end of the other handle H, and also carrying an adjustable thumb nut 33 for clamping the ends of the handles together in the bone clamping as well as in the wire-twisting operation. The slotted end of the handle H is also formed with out-turned lugs 34 forming curved seats for engagement with a flange 36 on the base of the nut 33, thereby permitting turning of the nut while preventing it from being pushed off the handle. The nut threads are broken, as at (Fig. 5) to permit sliding adjustment (on partial turning of the nut) along the bar, and thus eifect quick change in the handle adjustment. Index grooves 35 on the face of the nut facilitate positioning the same for such sliding adjustment, and the base of the nut has lugs 37 (at substantially right angles to the grooves 35) for engaging the slot 32 (on slightly relaxing the grip on the handlesthus locking the nut in any set position.

In the present construction the bar 36) is also suitably calibrated, as indicated at 40, for the purpose of utilizing the spread of the jaws (when clamped into engagement with the fracture) as a means of indicating to the operator the size or diameter of the bone, and hence the length of drill to use for the drilling operation, as well as the size of other parts, such as the screws necessary for attaching a plate when used for uniting the fragments.

In the present construction also the end of the slot l3, next to the tip end of the jaw I4, is reduced in width to form a narrow slit 2% (claw hammer style) for catching and holding one end of the wire fixation material 27. Moreover, for

facilitating such action, the wire material 21 is provided in double strands of suitable length connected and bent at one end to form a hook 29 especially adapted to be received and caught into the slit 26 and remain engaged therewith on withdrawal of the jaw M as represented in Figure 3.

As part of the equipment designed for carrying out the operation of introducing the wire fixation material into the fracture, I also provide a threading tool comprising a handle 42 carrying a slender wire shank 44 terminating in a twoprong fork 45 which is adapted to be inserted into the hook portion of the double-stranded wire 21, thus enabling the operator to thrust the said wire accurately through the drill guide element 2e and the slotted jaws with a minimum of time and effort, after which the threading tool may be easily withdrawn without any disturbance of the wires position or of the parts of the fracture.

The method of using the appliance for bone clamping and for drilling through the fragments 58 of a fracture is essentially the same as set forth in detail in the patent already referred to, including the adaptability of the device for carrying out the drilling operation at various angles due to the combined adjustments provided for through the medium of the separate curved slots as will be readily understood. Moreover, such a method of operation and the design of tapered ends of the jaws (which enables them to be positioned with a penetrating action between the bone and tissues) may be carried out in a minimum of space along the bone (not materially greater than the width of the clamping jaws) and hence with the least trauma and a minimum disturbance of the tissues. The scoop or curved shape of the lower jaw Id, with its side ridges Is, also adapts it fOr use as a curette in scraping the bone surface, where this becomes necessary. In addition to the advantage of directional control for drilling it is also to be noted that the calibrated locking bar 39 also serves to indicate the diameter 0f the bone fracture, and consequently the length of drill needed for the operation; and also, if plates are to be used for connecting the fragments, the size of screws which will be required for attaching such plates.

When the openings 5i! have been drilled, and a wire fixation material is to be used, as is usually indicated for long fractures of relatively small bones, such wire 27 is readily introduced through said drilled openings by the present method; that is, by means of the threading tool with its fork 45 engaged with the hooked end 29 of the wire, as illustrated in Figure 2said threading tool then being removed.

In the use of wire fixation, operators have heretofore experienced some diflieulty in withdrawing the lower or inserted end of the wire from the wound, as required before the ends of the wire can be twisted together; for without the provision of the improvements of the present invention no assurance is had that the retraction of the lower jaw of the tool will bring the lower end of the wire out with the jaw. The improved construction makes doubly certain of this result. In the first place, the hook 29 on the lower end of the wire provides a fairly positive means of engaging the end of the slot l8; and in the second place the provision of a narrow slit 26 into which such enlargement or hook terminal of the wire is firmly caught renders it practically impossible for the lower jaw to be withdrawn without also trailing the wire along with it. It will be understood that the hooked end of the wire, after being threaded through the fracture, is surrounded by tissue which acts to hold the end of the wire in place until it has been caught within the slit 26 as the lower jaw I4 is withdrawn as illustrated in Figure 3.

The handle members may be withdrawn either separately or together, according to the preference or technique of the operator, and in either case it is obvious that the upper portion of the wire is also withdrawn along with the upper jaw I2, out into the position illustrated in Figure 4, where all four strands of the wire are then evenly engaged by the clamping jaws for a neat twisting operation by means of the appliancewhereby the ends of the wire are drawn up around the fracture and securely fastened together in the usual manner.

It will therefore be apparent that I have devised a very practical and highly efficient appliance well adapted for the carrying out of all the stated objects of the invention, and that while I have illustrated one practical and satisfactory form of embodiment of the essential features of improvement, the same is susceptible of various modifications within the scope of my invention. I therefore desire to be understood as reserving the right to make all changes and modifications falling within the spirit and scope of the invention as defined by the appended claims.

Having thus described my invention, what I claim and desire to secure by Letters Patent is:

1. Means for clamping the fragments of a bone fracture and applying fixation material thereto, comprising pivotally connected bone clamping jaws having slots for accommodating bone-drilling operations, and wire fixation material for insertion through a drilled hole in the fractured bone and having a terminal enlargement, one of said slots terminating in a narrow slit for retaining engagement with said terminal enlargement of the wire.

2. Means for clamping the fragments of a bone fracture and applying fixation material thereto, comprising pivotally connected bone clamping jaws having slots for accommodating bone-drilling operations, wire fixation material for insertion through a drilled hole in the fractured bone and having a terminal hook portion, a threading device for engaging said hook portion and insserting said wire through the fracture, one of said slots terminating in a narrow slit for retaining engagement with said terminal hook portion of the wire.

3. A bone clamping device for fracture work, comprising pivotally connected bone clamping jaws, one of said jaws being of concave or scoop contour with longitudinal ridges along its opposite sides for serving as scraper edges.

4. A bone clamping appliance for fracture work, comprising pivotally connected handle members carrying bone-clamping jaws, and a clamping screw pivoted to the end of one of said handle members and carrying a nut for engagement with the end of the other handle member and the latter being provided with an open-ended slot for receiving said screw, said screw and nut having longitudinal threadless portions adapted, on partial turning of the nut, to permit sliding thereof along the bar, and said nut being also formed with a projection for locking engagement with said slot.

JOHN R. SIEBRANDT. 

